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PL-18-1370Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Project Address Permit Permit NO. PL-5-18-1370 Permit Type: Plumbing - Residential Work Classification: Septic Permit Status: APPROVED Issue Date: 5/2312018 Expiration: 11/19/2018 Parcel Number Applicant 1050 NE 107 Street Miami Shores, FL 33161-7374 1122320280520 Block: Lot: GABRIEL MARTIN KUSKUNOV Owner Information GABRIEL MARTIN KUSKUNOV Address 1050 NE 107 Street MIAMI SHORES FL 33161-7374 1050 NE 107 Street MIAMI SHORES FL 33161-7374 Contractor(s) USA PLUMBING & SEPTIC, INC. Phone 305-856-1696 CeII Phone Phone Cell Valuation: Total Sq Feet: $ 13,000.00 0 Type of Work: REPLACE EXISTING SEPTIC TANK AND DR Type of Piping: Additional Info: Bond Return : Classification: Residential Scanning: 3 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $0.00 $0.00 $0.00 $0.00 $300.00 $0.00 $0.00 $300.00 Pay Date Pay Type Invoice # PL-5-18-67621 05/23/2018 Credit Card 05/18/2018 Credit Card Amt Paid Amt Due $ 250.00 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: HRS Approval Final Review Plumbing In consideration of t - issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto anin strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assu - responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTR AL, PA MBING, ME ANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAV : .!#,:tt�Egoing informatio is accurate and that all work will be done in compliance with all applicable laws regulating construction and'.Art /, J � ze the above -named conttrracto dot envork stated. May 23, 2018 Authorized Signa, re: Owner / Applicant / C tractor / Aget Date Building Department Copy May 23, 2018 1 BUILDING PERMIT APPLICATION ❑ BUILDING PLUMBING JOB ADDRESS: Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 REc 8 Master Permit No ❑ ELECTRIC ❑ ROOFING ❑ REVISION Sub Permit No. ❑ MECHANICAL El PUBLIC WORKS ❑ CHANGE OF CONTRACTOR QSO NIC 10q Si t City: Miami Shores County: Miami Dade T\7vr) AY t 8'2018 (14 Fsc zo i�6Kei 90 1 ❑ EXTENSION 'ENEWAL ❑ CANCELLATION ❑ SHOP DRAWINGS Zip: 33 t,t • Folio/Parcel#: I % - 0.23a - 008 ` O'Sc9-0 • Is the Building Historically Designated: Yes Occupancy Type: Load: Construction Type: Flood Zone: OWNER: Name (Fee Simple Titleholder): GpBaL 140E60 V":03+WI1-r • Address: 10 WV - City: LU.t.. c61-F 4, Eb State: Twe►- NO BFE: FFE: Phone#: C) 88831S Zip: 331bI. Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: US 2041 3/Ali& f.66 0 ° I/"L Phone#:36-5-K64— l�6 74j Address: /��4/5 gip l 1 %�/t� I& City: b4//V? , State: rl.DRI k/% Zip: 3314 Qualifier Name: , . TOIkD i... GA RC 1,4 Phone#:7Z6j 9 76' / q-2 7 State Certification or Registration #: 2F- 6 6-90 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ t. COD . Square/Linear Footage of Work: Type of Work: ❑ Addition n Alteration ❑ New Description of Work: 11-$ % gefr ❑ Repair/Replace ❑ Demolition Specify colt$®1�1�' th�'u�le. '• Submittal Fee $ Permit Fee $ CCF $ Scanning Fee $ Radon Fee $ DBPR $ Technology Fee $ Training/Education Fee $ Structural Reviews $ it 7 < s4 .p ; •, CO/CC $ i. :.\.,`oil y.H J..,,�,..: I.N' ti'•"9� •n^�'t!'H/Y:+'�".': ,tt Notary $ Double Fee $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) i,,.: i• I \, ., Bonding Company's Address City - - ( State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City t 1 State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to'the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. : I "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance ofa building pp g permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first instion which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will nkt be approved and a reinspection fee will be charged. f A 1,31gnatg e� \ S �� ' Signature��/�� �� r If — I' \ ER,or AGENT he foregoing instrument was acknowledged before me this p day of 1-.."1-A: , 20 lig , by ,G4v.MA (1,.. /'JQt dl's personally known to CONTRACT The foregoing instrument was acknowledged before me this /0" day of I ,20 ,a ,by `Ye(, who islpersonally known to tb/JiO L. me or who has produced as me or who has produced as identification and who did take an oath. NOTARY PUBLIC: 1 (Sign: ' Print: ISeal: ����ct�(�► tl Aro oto, Notary Pubic State of Florida Catherine Petit My Commission FF 957875 *'tye? *iaKPipeAtA74T S!******** APPROVED BY identification and who did take an oath. NOTARY PUBLIC:, Sign: Print: Seal: ZZr Plans Examiner Structural Review Q3 SWAM Pi19Z uyC010LOSIONOFFHMO lorded Thy Wiry PideUnd n Zoning Clerk (Revised02/24/2014) r S-u ,. STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GARCIA, ANTONIO LUIS U.S.A. PLUMBING & SEPTIC INC' 415SW 19TH RD MIAMI FL 33129 Congratulations! With this license you become one of the nearly one million Floridians licensed by. the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in: order to serve you better. For information about our services, please log onto www.myfloridalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive.to.serve you better so that you can serve your customers. Thank you for doing business in Florida,_ and congratulations on your new license! RICK SCOTT, GOVERNOR allto (850) 487-1395 STATE OF FLORIDA DEPARTMENT OF,BUSINESS AND PROFESSIO,AL REGULATION CFC056905 ISSUE06/22/2016 NG"CONTRACTOR CERTIFIED PLUM GARCIA, ANTO(: LUIS'' U.S.A. PLUMBING& SEPTIIO;: IS'''CERTIFIED--under the provisions of Ch.489 FS. '"EXpiretior. date.: AUO 31, 2018 1.160622660079,3' + d..•A,t,jk,T,: DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD LICENSE NUMBER The PLUMBING CONTRACTOR Nart_aedbelow IS CERTIFIED - Under the provisions, of, Chapter 489 FS. Expiration date: AUG 3`1,n20148 .r r';4RrIA ANITClrrlln.I I IIC r'.<:. Mission: To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. Vision: To be the Healthiest State in the Nation Rick Scott Govemor Celeste Philip, MD, MPH Surgeon General and Secretary REGISTERED SEPTIC TANK CONTRACTOR ANTONIO L. GARCIA 415 SW 19TH ROAD MIAMI, FL 33129- SR0101664 U.S A. PLUMBING & SEPTIC, INC Business Authorization. SA0101704 1)ri epternber 30 204 Honda Department of Health Division of Disease Control & Health Protection Bureau of Environmental Health 4052 Bald Cypress Way, Bin A-08 *Tallahassee, FL 32399-1710 1111 Accredit Ith Departrnent 002750 Local Business Tax Receipt Miami -Dade County, State of Florida THIS IS NOT A BILL - DO NOT PAY 511.6819 BUSINESS NAME/LOCATION USA PLUMBING & SEPTIC INC 2745 NW 24 ST MIAMI FL 33142 RECEIPT NO. RENEWAL 37241GS OWNER EEC. TYPE OF DUENESS USA PLUMBING & SEPTIC INC - ••• • • 198 PLUMB1NGCONTRACTOR CFCB59905 Worker(s) 1 007025 EXPIRES EPTEMBER 30, 2018 NI!usi oa diaplayed at place of truslne3s Pursuant to County Code Chapter BA - Art. 5 & 10 PAVNMAIT pecelvtri RV TAX COLLECTOR 575.00 07/07/2017 CH ECK21 —17-052591 This LoCal Business Tax Receipt flail, coofitrospereeof of the local atodaase1 s Tits Hat eipt ntt e license. permit, at a certification of the holder's qualifications. w de business. Helder roust comply with say prEvemmental ar no0gavenanental regulatory laws and requIrscaonts Mitch apply to1146 110 A0641. The RECEIPT NO. above MUIR be displayed on ell commercial 4ghi&toa -Kstul-Ueds Cade Sec 8a-275. For more information. visit WWYLITI1,11.11nYat Local Business Tax Receipt Miami -Dade County, State of Florida -THIS IS NOT A BILL -DO NOT PAY 6217350 151.181,11811 NAME/LOCATION USA PLUMBING & SEPTIC INC 415 SW 19 RD MIAMI FL 33129 RECEIPT NO. RENEWAL 6482079 OWNER SRC. TYPE QV SUERNIMIS USA PLUMBING & SEPTIC INC 216 LPG INSTALLER EXPIRES SEPTEMBER 30, 2018 Must be displayed el oleos of business Pursuant to County Code Chapter BA - Art, 9 & 10 PAYMENT RECEIVED EY TAX COLLECTOR $60.00 07/06/2017 -- CHECK21-17-052350 This Local eueirtene MIS Receipt only confirms pigment al the Lco Tex. The Receipt is nal • liens.. permit. or a cr io;ri el the tickler's 4xeliticirtions, i5 hiasi Gets Yielder rause comply with any govemmarrtal or nongovernmental rosulonny k4oreond 'quit° ir a n iitisp;',1y tt las business. TM RECEIPT NO, above must ba displayed on 511coremorenn vehicles - blifsatl-Oade Cods Sot la-275. For more iaturreattert, adastar A Rom® 'CERT1FIG:ATE )F LIABILflY INSURANCE DATE(MMIDINYY.YY) 05,17n018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION •ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 'CERTIFICATE DOES -NOT AFFIRMATIVELY OR NEGATIVELYAMEND, EXTEND OR -ALTER THE COVERAGE AFFORDED BY THE POLICIES .: BELOW. THIS. CERTIFICATE OF INSURANCE DOES NOT.•CONSTITUTEA,CONTRACT BETWEEN THE. ISSUING INSURER(S),,AIJTHORIiED REPRESENTATIVE OR PRODUCER,, AND THE. CERTIFICATE HOLDER. IMPORTANT: If the certificate holder;;.is•an ADDITIONAL. INSURED, the:policy(ies) must have ADDITIONAL INSURED provisions •:orboendorsed. IfSUBROGATION ISS'WAIVED;°subjectto the.terms and conditions of the policy, certain policies may require anendorseaiant. •Aistatesaent<on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Eastern Insurance Group. Inc. 9570 SW 107Avenue Suites 104 Miami FL 33.17E`. c°'4.5A l Amanda Nogues NAME- UM n 7Efd}:' (305f SEE-3323` (A ,Noi' (305) 51 E-713Si EMAIL, amanda(easterninsurancemet: ADDRESS: INSURER(5} AFFORDING COVERAGE- MARCO_ ...... INSURERA _ Cavington Spedaity'In ,Trance Co-: 13027' INSURED: U-SAPlumbing&:Septic,-Ina 2745,>NW 244 Skeet. ;4 iarrn A. 33T47 INSURER. Br INSURERC:. INSURER.D : INSURER E : INSURER F : COVERAGES •CERTIFICATE"NUMBER: IMaster18119 REVISION NUMBER: THIS: IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED'$ELOW HAVE BEEN ISSUED TO THE fNSLIFt'ED NAMEDABOVEfORTHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITtON;OFtANY- CONTRACT OR OTHER DOCUMENT WITH' RESPECT TO WHICH THIS iCERTIFI.CGATEdi9MA'Y BE ISSUED DR WM PER IAIN., THE INSURANCErAFFORDEDiS THE POLCC ES•DFSCRtB,ED HEREIN is _SUBJECT TO ALL THE TERMS, :EXCLUBIONSAND CONDITIo 4S OF:SUC H•RVLICIESS. LIMITS'S-HtmN:MAY HAVE' BEEN REDUCEDSY RAID CLAIMS INSR LTR 'IYPE"Of,FNSURANCE ADULSUBR INSD INVD `P.OLICYN.UMBER 'POLICY EFF LMMIDDIYYYYL_ " POLICY-EXP IMM/DD/YYYY) LIMITS A X,COMMERCIALGENERALuABILfPr 05188E18 • 05713/2018 rEr\eCHOCCURRENCE 3.,1-,000,000 DAMAGE ID REN I ED -PREMIEES,(Eeo$ wT.nce) `6 100.000 'CUMIAS-MAUE OCCUR MED EXP (Any one person) $ 5,000 05/1312019 - PERSON&a..ADv IrvuRM b k,000;,000 GENERAL AGGREGATE. s.. 7,000,000 GEN'LAGGREGATE X LIMITAPPLIES PER:' POLICY JECT LOC OTHER:. - PRODUCTS; COMPIOPAGG &.. 2;000,000:. S: kUTOMOBILEUABitITY ^- ANY AUTO, O'NNEII AUTOS, ONLY HIRED AUTOS ONLY -SCHEDULED AUTOS. NON -DWELT. AUTO5ONLY C MBINEflSINGLE UMIT (a accident). BODILY. INJURY- (Per' person) $ EIODILYIN.LURY'(Per :acodeni)- 'ROPERTY DAMAGE per acacia* •OCCUR UMBRELLA UAB EXCESS. LIB r ' 'CLAI105k4.ABE I 1EA4�H.�06CORRENCE $. AGGREGATE '$ '3 'DEO ; :RETEMYON:3 -:' WORKERS .COMPENSATION ANDEMPIINERS LIABILITY :I/.11 MANY PR01?RIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory.In'NH) It. yes. desorIbewnder DESCRIPTION. OF.OPERATIONS below - .N PER 'OTH- ,STATUTE. ER EL_ EACHACCIDEET EL DISEASE -EAEMPLOYEE 1$ E. L.DiSEASE—POLICY LIMIT S 1 i I. r i DESCRIPTION: OF OPERATIONS?A LOCARRONS'AVEHICLES (Kona 104AddidoeelAltrnadts Sthedale, may be attiutheOltmeeeepaar ieired)' Plumbing Contractor ana Septic Tanks CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050'NE2lAvenue • Mienii Stares ACORD 25 (2016/03) 'SHOULD ANY OF TOE ABOVE 'DE'SCRIB EDI POLICIES't E CANCELLED BEFORE THE EXPIRATION DATE THEREOF; NOTICE•W?LL BE DELIVERED IN ACDORDANCE INTH !DIE PO UCYPROVISION$. ,'AUTHORIZED REPRESENTATIVE FL '33'138 @ 1998 2015 ACORD CQRRFX3RAT#ON. All rights reserved. The ACORD name and logo are registered marks of ACORD JEFF ATWATER CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 8/15/2017 EXPIRATION DATE: c821,5/201.9H! PERSON: GARCIA ANTONIO L FEIN: 562360872 BUSINESS NAME AND ADDRESS: U.S.A. PLUMBING & SEPTIC, INC. 415 SW 19 RD. MIAMI FL 33129 SCOPE OF BUSINESS OR TRADE: Licensed Plumbing Contractor Plumbing NOC and Drivers Sewer Construction t::i All Operations and Drivers IMPORTANT: Pursuant'to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt.. apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to betexempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person namedon the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 U.S.A. PLUMBING & SEPTIC INC. STATE CERTIFIED PLUMBING CONTRACTOR CFC 056905 415 S.W.I9 Rd. MIAMI, FLORIDA 33129 OFFICE: (305)-856-1696 - FAX: (305) 859-8879 - E-MAIL: usaplumbinginc@aol.com WEB SITE: www.usaplumbingandseptic.com 5/10/2018 STATE OF : FLORIDA COUNTY OF : DADE BEFORE ME THIS DAY PERSONALLY APPEARED ANTONIO L.GARCIA WHO, BEING DULY SWORN, DEPOSES AND SAY: THAT HE OR SHE WILL BE THE ONY PERSON WORKING ON THE PROJECT LOCATED AT : 1050 NE 107 ST MIAMI, FL 33161 ONTRACTOR SIGN • TURE SWORN TO (OR AFFIRMED) AND SUBSCRIBED BEFORE ME THIS 10th DAY OF MAY, 2018. PERSONALLY KNOW OR IDENTIFICATION TYPE OF IDENTIFICATION PRODUCED 1/(-C4j-7‘F:12 - eA- e-•ere/Z., PRINT TYPE OR STAMP NA i4OTERY ..■fir ^11®ZT mYCOMI IOM#FF983810 D NRGV.�19, 2020 Notice to Owner — Workers' Com p Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' s mpensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIG I BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTEN Signature: wner State of Florida County of Miami -Dade The foregoing was acknowledge before me this IQ day of By r7N. _. S IlV N who is personally known to me or has produced 400 W Notary Public State cs Fiorwca . Catherine Petit My Commission FF rssie/o p a. Expires 02/07/2020; identification. BUILDING PERMIT APPLICATION BUILDING ❑ ELECTRIC EISLUMBING ❑ MECHANICAL Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ❑ ROOFING JOB ADDRESS: 1©SO /)E' (0-) RECEIVED AUG 1 2015 BY: -4 E ` M, `-S FBC ZO 144 Master Permit No. "FL - e 5 -26 S Sub Permit No. ❑ REVISION EXTENSION ❑ RENEWAL PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS City: Miami Shores County: Folio/Parcel#: -n22 32 -021e_os-2O Is the Buil Occupancy Type: (2 S Load: Construction Type: OWNER: Name (Fee Simple Titleholder): Address: ✓,/®, O /ll C— /'O City: 7T7 /,9 in I SAD-rr Tenant/Lessee Name: Phone#: Email: �t . sIP�, ' :1A T-1. 7 j Phone#: C I )J%� sF�o 05b—/� CONTRACTOR: Company Name: ,. ,� State: Sc74-- Zip: 33/ & I ally Designated: Yes NO >O BFE: FFE: kt/Skono4'4hone#: ?OS- 9921 Address: Lt ' S GOLJ q City: M 1 v { /I Qualifier Name: ' N l o6E J c (cc. State Certification or Registration #: �', c'., 06 c CJ, DESIGNER: Architect/Engineer: K.0101 q Address: City: State: Value of Work for this Permit: $ Type of Work: ❑ Addition ❑ Alteration n New Repair/Replace Description of Work: R c P L A -%x7 / to G S� ZAP -7) e - l �f � K. laS 1}.reiL iN 1NT Stip) c- /'' Zip: 3 3' 2 �7 Phone#:51--9 /'6—/ ( 2. 7 Certificate of Competency #: Phone#: State: • " Zip:• Zip: 3 3 /6/ Square/Linear Footage of Work: n Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ 300, 7' CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ LU() 0 TOTAL FEE NOW DUE$ �29 s O (Revised02/24/2014) �3B.e.,C Bonding Company's Name (if applicable) 4 Bonding Company's Address City State Zip a Mortgage Lender's Name (if applicable) Mortgage Lender's Address r l City 1. State .74/ Zip 1t,• 2, i.' I +y e 'R.a-4 Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior,to'the issuance,of,a permit and that all work will be perfo'rnied to meet thestandards of all laws "regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, AIR CONDITIONERS, ETC I ,. 1a if + _..a OWNER'S AFFIDAVIT: l certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE' TO RECORD A' NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING�TWICE F'OR;IMPROVEMENTS.TO-YOUR PROPERTY. IF YOU INTEND TO OBTAIN'FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the i� uance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the nbficA of commencement d construction lien law brochure will be delivered to the person whose property is subject to attachment. ,o;'o candied copyo t recorded notice ofcommencement must beposted at the job site .ff for the first inspection which occurs seven (7) days after the bill ing permit is issued. In the absence of such ,posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature (14Q The foregoing instru day of OWNER or AGENT t was acknowledged before a this 44 , by , who is personally known to m or who oZ 9c3 r���'��- , g ��GLIGP�_ ide(Nett—Ilan d who did iar an oa . NOTARY PUBLIC: Sign: Print: ' +i vlb,MARIA L WELLS ;'P +� . MY COMMISSION,# FF 076074 S. i.= EXPIRES: December 21, 2017 `' Bond - • Yku No . / , • as , tary Ps UndenwRen �AfrA4 7pjs� Seal: .,/t/ APPROVED BY 4 Y Structural Review Clerk CONTRACTOR The foregoing instrum t was acknowl dged be ore mie t is 7_. day of , 201 , by fe ersonally knowr o me or who has pro identificatior and who did take an oath. NOTARY PUBLIC: Sign: Prin ,�/ Seal: 1X • :ei+ ey4 MARIA L WELLS MY COMMISSION # FF 076074 ▪ j EXPIRES: December 21, 2017 Bonded Thru Noy Public Underwriters ;q 1: r as b Plans Examiner Zoning r -1 1 e (Revised02/24/2014) AUG-5-2015 1044A FROM: TO:3057562972 P.11/14 Mission, pe4;,1 it' c iurry S ;.•4.1.1.•:-!;L4tiztvpfTit • Florida Department of Hoaith Lrr cla! f4.79IT 4 ; • ;I;••• Rick Scott John H. Armstrong, MD, FACS Vision''''P Ris.'lhiestSte. REGISTERED SEPTIC TAN CONTRACTOR A.I.,ITCNIY) GAR. IA 415 SW 43TH kC MIAMI, f L 33129- SR0101664 USA PLUMBiNC Business Author!: & SEPTIC INC ton SA0101704 Registration expires or SepIfinnber -30 2015 Www-FloridasHealth.com "K .1 0 !, +rt• • - i.; AUG-5-2015 10:44A FROM: T0:3057568972 P.10/14 Authorization Number Date Issued ANTONIO L GARCIA U.S.A. PLUMBING & SEPTIC, INC. 415 SW 19TH ROAD MIAMI, FL 33129- .116 FLORIDA DEPARTMEN CERTIFICATE OF AUTHORIZATION FO HEALTH The Florida Department of Heahh hereby certifies the business or entity name III, Chapter 489, Florida Statutes, for septic tank contracting and has been septic tank contracting cervices under the OF HEALTH SEPTIC TANK CONTRACTING below has satisfied the requirements of Part authorized by the Department to provide rue of U.S.A. PLUMBING & SEPT ,C, INC. Q*1itlring Contractor. ANTONIO L G SA0101704 February 18, 2015 March 31, 2017 Expiration Date AUG-5-2015 10:42A FROM: TO:3057568972 P.5/14 0 om HEALTH 13-QG-00110 Issued To: Mail To: U S A Plumbing & Septic Inc 2745 NW 24 Street Miami, FL 33142 Antonio Garcia 415 SW 19 Road Miami, FL 33129 STATE OF FLORIDA DEPARTMENT OF HEALT Operating Permit OSTDS Service • SDS' 13-BID-2798260 County Dade Amount Paid 5'257.50 Date Paid 06/29/2015 Issued Date 07/01/2015 Permit Expires On: 09/30/2016 I ued By: D partment of Health in Dade County 1 805 SW 26 Street ami, FL 33175 315-2444 Owner: Garcia, Antonio SOS Trucks: 1 TTS Trucks: 0 The facility shown above has been inspected by a duly authorized representative of th Department of Health. and was found In conformance with those rules promulgated: by the department under the authonty of ch - pters 381.386 and 489 part III, Florida Statutes, and set forth in Rule 64E-6, Florida administrative code This permit grants authonty to operate the above referenced facility, service, or syste In conformance with department rules and the conditions of operation shown below This permit is revocable, upon service 0 ntotice, when it is determined by the department that the operational conditions and department standards are not being m4ntatned.. This permit is for the operation of a septage disposal service Truck(s) shall be presented for the required annual inspection upon request from the Department. 'OSTOS Service Permit Abbreviations: SOS - Septage Disposal Service TTS - Temporary Ta ATUM - ATU Maintenance Entity LSF - Limo Stabilization Facility TM -• Tank Manufacturer Original Customer USA Plumbing & Septic Inc (NON -TRANSFERABLE) MEM HEALTH 13-QG-00110 Issued To: Mail To: U S A Plumbing & Septic Inc 2745 NW 24 Street Miami, FL 33142 Antonio Garcia 415 SW 19 Road Miami, FL 33129 Owner: Garcia, Antonio STATE OF FLORIDA DEPARTMENT OF HEAL Operating Permit OSTDS - Service - SDS Service LAS - Land Application Site DISPLAY CERTIFICATE IN A CONSPICUOUS PLACE 13-BID-2798260 CountyDade Amount Paid: $257..50 Date Paid: 0629/2015 Issued Date: 07/01/2015 Permit Expires On: 09/30/2016 I tsued By: Depanment of Health in Dade County V1805 SW 26 Street f iami, FL 33175 ( '86) 315-2444 AUG-5-2015 10:42A FROM: TO:3057568972 P.4/14 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESS( CONSTRUCTION INDUSTRY LICENSING BOAR 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GARCIA, ANTONIO LUIS U.S.A. PLUMBING & SEPTIC INC 415 SW 19TH RD MIAMI FL 33129 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers. td barbeque restaurants, and they keep Florida's economy strong. Every day we work 10'improve the way we do business in order to serve you better. For information about our sevices, please log onto www.myfloridalIcense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently; Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE RICK SCOTT, GOVERNOR STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFES IONAL REGULATION CONSTRUCTION INDUSTRY LICEN ING BOARD `NAL REGULATION (850) 487-1395 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND , PROFESSIONAL REGULATION CFC056905 - ISSUED: 06/15/2014 (CERTIFIED PLUMBING CONTRACTOR GARCIA, ANTONIO LUIS U,S.A. PLUMBING & SEPTIC INC S CERTIFIED under the provisions of Ch 489 FS Expiation dalo AUG 31, 2018 114D6150001244 KEN LAWSON, SECRETARY LICENSE NUMHER The PLUMBING CONTRACTOR Named below IS CERTIFIED Under theprovisions of Chapter 489 FS. Expiration date: AUG 31, 2016 GARCIA, ANTONIO LUIS U.S.A. PLUMBING & SEPTIC INC 415 SW 19TH ROAD MIAMI FL.33129 AUG-5-2015 10:44A FROM: TO:3057568972 P.13/14 Local Business Tax Receipt Miami —Dade County, State of Florida THIS I , NOT A OIL 1 LU NOT PAY M 6819 BUSINESS NAME/LOCATION USA Pt MIRING & SEPTIC: INC 1451`4;112.4 ST MIAMI FL 37ci 142 OWNER USA PLUMBIN A cE PTIC INC. bVrirkt•rt RECEIPT NO RENEWAL 3724169 SEC. TYPE OF BUSINESS 19t, Pi OMBINCi C'-JNTf;At.TOR ;rie ,:rlC EXPIRES SEPTEMBER 30, 2015 -17, F' • ,;,i'i' !i.- C su'dy t OOP ipti r NA Art ft A 10 This Local Business Tax•Recnipt only conlunis payment of (Ito t:!;a! Business Tait The Re permit. or a r.,andreaban otiho holder c qu3!!h; Moons to no buc,ne;s 1t Mier trust c ompi'' ornongovei,- r,!,ilregulatoryiaevsandtelt,:ierrentxwh!ch,rpp! 1 !"eCt-sleesr The RLCEIPI NO ahure n14»! bB dicptaycd on ell commorua, vehicles • A?iarni Da For tango infoiinanoti visit wy/iy nnitrnidti!Jn,ga iyolIneJor Local Business Tax Receipt Miami —Dade County, State of Florida THIS IS NOT A BILL DO NOT PAY 6217350 BUSINESS NAME/LOCATION. USA PLUMBING & SEPTIC INC 415 SW 19 RD MIAMI FL 33129 OWNER USA PLUMBING & SEPTIC INC RECEIPT NO. RENEWAL 6482079 SEC. TYPE CIF BUSINESS 20B LPG INSTALLER LPG023745 PAYMENT RECEIVED BY TAX COLLECTOR 04.y!l"21—, eipt is not a license, vuh any governmental Codo Sri, 8a• lri: BT EXPIRES SEPTEMBER 30, 2015 Mus be displayed at place Of business Pursuant w County Codo Chapter BA Art 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR $60.00 07/16/2014 CHECK21-14-020516 This! .coal Business Tax Reeelpt only confirm payment.ol the Local Business Tax. ho Receipt Is not *Rennet permit or a canification of this holder s quelihca•tioni. to do business, Koh beringr mot . oaipiy with any geyetnmental or nongovernmental repu}atorjl laws and e.quuamuus witch apply The RECEIPT NO. abpvq must be displayed on all commercial vehicles- tdiaint-Dade Coda Sec Ile-178. Formateinformation, visityvww•miomidedP9lILtr.yn 3stgt AUG-5-2015 10:45A FROM: T0:3057568972 P.14/14 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SER •CES DIVISION OF WORKERS' COMPENS 4 ION • " CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORK : ' S' COMPENSATION LAW • * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Work rs' Compensation law. EFFECTIVE DATE: 8/16/2015 EXPIRATION DATE: 8/15/20 PERSON: GARCIA ANTONIO L FEIN: 562360872 BUSINESS NAME AND ADDRESS: U.S.A. PLUMBING & SEPTIC, INC. 415SW19RD. MIAMI FL 33129 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING PLUMBING NOC AND CONTRACTOR DRIVERS SEWER CONSTRUC ON ALL OPERATI Pursuant to Chapter 440.05(14), F.S., en officer of a corporation who elects exemption from thls chapter by filing a coo (Uccle of election under this section may not recover benefits or compensation under this chapter_ Pursuenl to Chapter 440.05(12). F S . Certificates of al . Ion to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.06(13) F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation If, at any time after the filing of the not or the Issuance of the certificate, the person named on the notice or cettlficste no longer meets the requirements of this section for Issuance of a certifi te. The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 AUG-5-2015 10:44A FROM: TO:3057568972 P.12/14 Florida Department of Agriculture and Cons P.O. Box 6700 Tallahassee, Florida 32399-671 License Number: 23603 Business Mailing Address U.S.A. PLUMBING & SEPTIC, INC. 415 SW19TH RD MIAMI, FL 33128-1313 The liquefied petroleum gas li.:ense at the bottom of this form is valid ONLY f on the license. Each business location of a company must be licensed. All L annually. Any license allowed to e:{pire shall become inoperative because of restoration of a license is equal to the original license fee and must be paid b operations. IN THE EVENT OF AN OWNERSHIP CHANGE AT THIS BUSINESS transferred to any person, firm or corporation for the remainder of the current the department by the original license holder. License transfers must be app requirements must be met by the transferee and a transfer fee of $50 will app Bureau of LP Gas Inspections at (850) 921-1600. Pursuant to Chapter 527, Florida Statutes, LP Gas licensees must present p owner, or end user upon request when engaged in the business of servicing, installing LP Gas systems and/or equipment. For future correspondence; please make any needed corrections or changes and/or your licensed location address and returnthe UPPER PORTION with POST UCENSE CONSPICUOUSLY Florida Department of Agriculture and Con P.O. Box 6700 Tallahassee, Florida 32399-67 Cut Here State of Florida Department of Agriculture and Con Division of Consumer Service Bureau of Liquefied Petroleum Gas I (850) 921-1600 Tallahassee, Florida Liquefied Petroleum G LP GAS INSTALLER GOOD FOR ONE LOCATION ONLY ANY CHANGE OF QWNERSHIP OR SALE OF THIS BUSINESS - NDERS THIS UCENSE INVALID This license Is; Issued under authority of Section 627.02, FIS ride Statutes. to: + f mer Services icensed Location Address .SA. PLUMBING & SEPTIC, INC. 745 NW 27TH AVE IAMI, FL 33142-6536 the company located at the address Gas licenses must be renewed ilure to renew. The fee for ore the licensee may resume "LOCATION: This license may be cense year upon written request to ved by the department. All licensing . To apply for a transfer, contact the of of licensue to any consumer, sting, repairing, maintaining or your business mailing address rrections to: mer Services 0 umer Services License Number: pection Expiration Date: Date of Issue: License Fee: Type and Class: License U.S.A. PLUMBING & SEPTIC, INC. 2745 NW 27TH AVE MIAMI, FL 33142-6536 23603 August 31, 2016 September 1, 2015 S200.00 0803 PUT N M COMMISSIONER OF AGRICULTURE AUG-5-2015 10:43A FROM: TO:3057568972 P.9/14 Your Medical G Installers Name: Antonio Garcia MEDICAL GAS CERTIFICA NPPA 99 2012 EDITION -ASS Installer ASME Boller and Pr Section IX CILB Course N000 this card complies with the requirements and has brs2 month period. (Ili 11 �� lia EXPIRES: 1013112015 ID# 07-04 CERTIFIED BY: UNITED SERVICE T United Service Training Corp, 2201 N Andrews Avenue Suite 101, Pompano Beach, Phone # 954975-5300 • Fax # 954-975-53 s Card ION fifes solo. ure Code 291. Bearer or PA renewal within a 6 111 0-09 INING CORP. L 33069 1 ao • TO:3057568972 G State of Florida Bureau of LP Gas Inspection QUALIFIER IDENTIFICATION CARD n onno tits Garcia 08-03 LP Gas Installer A This qualifier identification card is evidence that this person has passed a competency examination administered by the State of Florida. and may act as QUALIFIER for an LP gas company licensed in the category above pursuant to Chapter 527, Florida Statutes. This card is NOT A LICENSE TO DO BUSINESS IN THE STATE OF FLORIDA. ADAM H. PUTNAM COMMISSIONER OF AGRICULTURE CERT NO: 23745 Expires: March 11, 2017 U.S.A. PLUMBING & SEPTIC INC. STATE CERTIFIED PLUMBING CONTRACTOR CFC 056905 415 S.W.19 Rd. MIAMI, FLORIDA 33129 OFFICE: (305)-856-1696 - FAX: (305) 859-8879 - E-MAIL: usaplumbinginc@aol.com WEB SITE: www.usaplumbingandseptic.com State of 6/0 /��-- County of / r Before me this day personally appeare ie/V L .�/ c io, being duly sworn, deposes and says: That he or she will be the only person working on the project located at / 25 , /� /cz - / ' 7 Sworn to (or affirmed ) and subscribed before me this day of Personally know .20JJ , by OR Produced identification A) Type of Identification Produced Print, Type or Stamp Name of Nota F"'% MARIA L W �. MY COMMISSION N FF 076074 sa�. %; s EXPIRES: December 21, 2017 7�1i'�•'• •`• Bonded Thru Notary Public Underwrkers .Af„i4`� Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNIN : ELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: ' Owner State of Florida County of Miami -Dade The foregoing was acknowledge before me this ` day of B�B� EL if/] ` i 6.1eL111-0iXpersona known to me or has produced ' 7 /-2 93 ,- 3 - Notary: sa' as identification. "" "1, MARIA L WELLS ,.."1 MY COMMISSION # FF 076074 ti' ' EXPIRES: December 21, 2017 g f �y; Bonded Thru Notary Public Underwriters STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Gabriel Martin PERMIT #: 13-SC-1623294 APPLICATION #: AP 1199686 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR983962 PROPERTY ADDRESS: 1050 NE 107 St Miami, FL 33175 LOT: 1 BLOCK: 4 SUBDIVISION: PROPERTY ID #: 11-2232-028-0520 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LO('AT, PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ A [ N [ K [ GALLONS / GPD GALLONS / GPD new septic tank 0 ] GALLONS GREASE INTERCEPTOR CAPACITY ] GALLONS DOSING TANK CAPACITY D [ (300 ] QUARE FEET R [ ` SQUARE FEET A TYPE SYSTEM: [x] STANDARD I CONFIGURATION: [ ] TRENCH CAPACITY CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] new bed confiq. drainfield SYSTEM SYSTEM [ ] FILLED [ ] MOUND [ ] [x] BED [ ] N F LOCATION OF BENCHMARK: Crown of road NE 107 ST: 9.36' NGVD I ELEVATION OF PROPOSED SYSTEM SITE E BOTTOM OF DRAINFIELD TO BE L D FILL REQUIRED: 0 T H E R [ 0.00 ] INCHES [ 3.84 ] [I INCHES / FT ] [ ABOVE /) BELOW [ 41.88 ] [[ INCHES / FT ] [ ABOVE /)BELOW BENCHMARK/REFERENCE POINT BENCHMARK/REFERENCE POINT EXCAVATION REQUIRED: [ 50.00] INCHES 1.-Install a 900 gal min. septic tank with an approved filter. 2.-The licensed contractor installing the system is responsible for installing the minimum category of tank in accordance with s. 64E-6.013(3)(f), FAC. 3.-Install 300 sf of drainfield in bed configuration. 4.-Install 12" of slightly limited soil at the bottom of the drainfield. 5.-Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption bed or drain trench. (Comments Continued on Page 2.) SPECIFICATIONS BY: GUILLERMO SUAREZ, APPROVED BY: DATE ISSUED: Yudeiay Martin 08/10/2015 TITLE: TITLE: Engineering Specialist II DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Dade CHD EXPIRATION DATE: 11/08/2015 Page 1 of 3 v 1.1.4 AP1199686 SE968411 DOCUMENT # : PR983962 6.-Invert elevation of drainfield to be no less than 6.37' NGVD. 7.-Bottom of drainfield elevation to be no less than 5.87' NGVD. 8.-This permit includes the abandonment of the existing septic tank. The system is sized for 2 bedrooms with a maximum occupancy of 4 persons (2 per bedroom), for a total estimated flow of 300 gpd. THIS PERMIT IS NOT FOR ANY ADDITIONS. a InsPqcige Address 11)5b c reoirtii2 trkts: , . 1Y1,LiqmIrpdc14 Coo Tits, 118125,6,11726t .1.si.reet,,Avilmit-4 3,3 11-) et. ,LUT S474 ID INTS:I kr\O"1- sto tEny.11:99Mcatatiligalth, • 901):54P 5 D kei )IEt b ll re